wine

Say Goodbye to Your Merlot

Dear Women of Childbearing Age,

We regret to inform you that we have decided that you are no longer competent beings with a brain capable of making decisions about your life and how you live it.  As such, we have issued a statement that you should no longer be drinking any alcohol unless you’re using birth control for fear you might have a child with Fetal Alcohol Spectrum Disorder (FASDs).  That’s right, your life decisions should be dictated solely by the possible outcome of a possible future pregnancy, regardless of any other factors in your life.

You don’t drink to drunkenness you say?

Doesn’t matter.  As we are clear, we don’t know how much alcohol it takes to cause FASD.  Except we kinda do.  We have just chosen to ignore the large-scale, prospective studies that have shown light to moderate drinking does not result a greater risk of FASD or pregnancy problems (e.g., [1][2][3][4]), especially in the early days before you know you’re pregnant.  Instead we focus on studies large enough to find statistical significance with light alcohol use, even though it accounts for such little variance (like 1%) compared to other variables (like maternal psychopathology) to be practically meaningless[5].  In fact, we will blatantly ignore that all the studies that have examined FAS have found heavy drinking to be the factor and that in the 80s and 90s when “moderate” drinking was found to sometimes be a risk factor, moderate drinking constituted 3-5 drinks per day (e.g. [6]), a standard that is hardly “moderate” by today’s measures.

You’ll stop drinking once you’re pregnant you say?

Not only do we not trust you to not drink, but how on earth will you know you’re not pregnant on time?  Missed period you say?  But what if the damage is done?  “Alcohol can permanently harm a developing baby before a woman knows she is pregnant,” said CDC Principal Deputy Director Anne Schuchat, M.D. “About half of all pregnancies in the United States are unplanned, and even if planned, most women won’t know they are pregnant for the first month or so, when they might still be drinking. The risk is real. Why take the chance?”  How does this happen?  As the head of the American College of Obstetrics and Gynecology has reported, “alcohol can quickly reach the fetus’s underdeveloped liver and brain through the placenta”.  See?!  You’re just playing Russian roulette here. 

You think the fact that the placenta doesn’t take over the transfer of nutrients until the end of the first trimester matters?  What about recent research that shows us how drinking early in pregnancy – even before knowing you’re pregnant! – can cause negative outcomes because it results in epigenetic changes to the embryo[7].  The fact that the study is on mice and these ethanol-exposed mice were given only an ethyl alcohol mix to drink instead of water (with a regular average blood alcohol level of .10-.12), making it more comparable to a person deciding to forgo other liquids in favour of alcohol only, isn’t something you should concern yourself with.  Or that the period tested may have been the first 8 days of gestation for a mouse, but correlates with the time period that is 4 weeks post-fertilization in humans (i.e., when you know you’ve missed your period).  Just ignore all that. We are.

Taking the birth control pill? 

Oh – okay, that’s fine.  We’ll just ignore that most women don’t use it properly making its effectiveness lower than the stated 99.9% (more like 92%; yes, 8 out of 100 women will get pregnant on the pill[8]).  We’ll also ignore that it comes with a host of side effects that you have to bear the brunt of should you suffer from them.  These include the more “mild” nausea, weight gain, and mood changes or the more serious liver disease, stroke, blood clots, high blood pressure, and more.  That’s your problem, and in case it isn’t clear, we don’t really think much of you anyway.  

Using other birth control methods?

Okay, we’ll let this go too even though the actual effectiveness can be as low as 68%.  In our world, this means you are still not at risk of having a child with FASD.  Either our stats people forgot to look at actual effectiveness over theoretical efficacy or we just expect you to have an abortion anyway, so no harm done in our minds. 

What we do know is that we have a problem and it’s clear to all of us at the CDC that you – women – are to blame.  When we say that 1 in 20 children are on the fetal alcohol spectrum, we are not basing this on clear cut criteria, but rather behaviours like hyperactivity and attention problems that might be linked to FASD, so we’ve decided to link them conclusively.  We don’t want to talk about the fact that these behaviours are incredibly normal in childhood[9][10] but we have a school system and society that doesn’t support them.  We don’t want to talk about the fact that our expectations for children have shifted so much that we no longer expect children to be children, but rather to be mini-adults, and when they can’t meet this expectation because it’s not biologically normal, we instead will look to you – mom – as the cause of these problems.  We want to ignore that if we just shifted the way we think about childhood and how we treat children, we might not have $5.5 billion in costs each year from the various mental and associated physical disorders we’re linking to FAS instead of a society that piles anxiety upon kids starting in preschool.

It’s clear to us that it makes much more sense to ignore the societal problems and focus our efforts on condemning all women as being irresponsible and incapable based on no science that supports such a stance.  Making public statements about your capacity to make decisions for your body and passing the buck onto doctors to patronize their female patients is a much better plan than looking at the systemic issues that result in binge drinking more generally and binge drinking in pregnancy more specifically (both signs of mental health problems).  In fact, our intervention focus will always be on getting you to stop drinking or start birth control (and we’re not even going to look at the actual risk of FASD, just the risk of an alcohol-exposed pregnancy).  We don’t care why you drink or how else we can help you, only your not-yet-conceived child.

You’re welcome,

The CDC

_______________________________

[1] Kelly Y, Sacker A, Gray R, Kelly J, Wolke D, et al. Light drinking during pregnancy: Still no increased risk for socioemotional difficulties and cognitive deficits at 5 years of age? Journal of Epidemiology and Community Health 2010; doi:10.1136/jech.2009.103002.

[2] Kelly Y, Sacker A, Gray R, Kelly J, Wolke D, Quigley MA.  Light drinking in pregnancy, a risk for behavioural problems and cognitive deficits at 3 years of age?  International Journal of Epidemiology 2009; 38: 129-40.

[3] McCarthy FP, O’Keeffe LM, Khashan AS, North RA, Poston L, et al. Association between maternal alcohol consumption in early pregnancy and pregnancy outcomes.  Obstetrics & Gynecology 2013; 122: 830-7.

[4] Skogerbø A, Kesmodel US, Wimberley T, Støvring H, Bertrand J, et al. The effects of low to moderate alcohol consumption and binge drinking in early pregnancy on executive function in 5-year-old children.  BJOG 2012; 119: 1201-10.

[5] Sood B, Delaney-Black V, Covington C, Nordstrom-Klee B, Ager J, et al. Prenatal alcohol exposure and childhood behavior at age 6 to 7 years: I. Dose-response effect.  Pediatrics 2001; 108: e34.

[6] Coles CD, Brown RT, Smith IE, Platzman KA, Erickson S, Falek A. Effects of prenatal alcohol exposure at school age: I. Physical and cognitive development. Neurotoxicology and Teratology 1991; 13: 357-367.

[7] Marjonen H, Sierra A, Nyman A, Rogojin V, Gröhn O, et al. Early maternal alcohol consumption alters hippocampal DNA methylation, gene expression and volume in a mouse model.  PLoS One 2015; 10: e0124931.

[8] https://www.optionsforsexualhealth.org/birth-control-pregnancy/birth-control-options/effectiveness

[9] Bongers IL, Koot HM, van der Ende J, Verhulst FC.  Developmental trajectories of externalizing behaviors in childhood and adolescence.  Child Development 2004; 75: 1523-37.

[10] Keenan K, Wakschlag LS.  Can a valid diagnosis of disruptive behavior disorder be made in preschool children?  American Journal of Psychiatry 2002; 159: 351-8.